Incidence and Risk Factors for Diffusion-Weighted Imaging (+) Lesions After Intracranial Stenting and Its Relationship With Symptomatic Ischemic Complications

Abstract

Background and Purpose-Little is known about high-signal lesions in magnetic resonance diffusion-weighted imaging (DWI [+]) after stenting for intracranial atherosclerotic stenosis. This study aimed to evaluate the incidence, distribution, risk factors, and clinical implications of DWI (+) after intracranial stenting. Methods-A total of 123 patients (male:female=88:35, mean age, 64.1 years) with symptomatic intracranial atherosclerotic stenosis (mean stenosis, 76.1±7.7%) underwent both stenting and poststenting DWI. The incidence, distribution (embolicalone versus stenosis-associated perforator/mixed), and risk factors of DWI (+) and its relationship with symptomatic ischemic complications (SIC, including stroke or transient ischemic attack) were retrospectively evaluated. Results-Forty-three patients (35.0%) had DWI (+). Middle cerebral artery, smaller distal parent artery, and treatmentrelated dissection were independent risk factors for DWI (+) (P<0.05). SIC occurred in 4 patients (3.3%), all of whom had DWI (+). Of the patients with DWI (+), neither the number nor the volume of DWI (+) differed significantly between SIC and asymptomatic patients: median number/patient, 3.5 (range, 2-11) versus 2.0 (range, 1-11) and median volume/ patient, 329.8 mm 3 (range, 76-883.5 mm 3 ) versus 119.5 mm 3 (range, 32.5-873.0 mm 3 ). However, SIC occurred more frequently in the stenosis-associated perforator/mixed type (3/11, 27.3%) than in the embolic-alone type (1/32, 3.1%; P<0.05). Conclusions-The incidence of DWI (+) after intracranial stenting for intracranial atherosclerotic stenosis was 35.0%.Middle cerebral artery, smaller distal parent artery, and treatment-related dissection were independent risk factors for DWI (+ Stenting ProcedureAll patients received dual antiplatelet premedication (aspirin 100 mg and clopidogrel 75 mg daily) for ≥5 days before the procedure. All intracranial stenting was performed under local anesthesia. A bolus of heparin 3000 IU was administered intravenously immediately after placement of a 6F shuttle guiding sheath (Cook, Bloomington, IN) or a 6F Envoy guiding catheter (Cordis, Miami Lakes, FL) into the cervical internal carotid artery or vertebral artery. Thereafter, 1000 IU/h was administered. After completion of the procedure, heparin was stopped, but not reversed. Balloon-expandable coronary stents (Driver, Medtronic, Minneapolis, MN; FlexMaster, JOMED, Rangendingen, Germany; Vision, Guidant, St. Paul, MN) were used before the introduction of the Wingspan stent in March 2010. However, the Wingspan stent has been used exclusively since its introduction. Wingspan stenting was performed using a previously reported procedure.18 Prestenting balloon angioplasty always preceded Wingspan stenting using the Gateway balloon. Whether or not to perform prestenting balloon angioplasty during balloon-expandable stent (BES) insertion was decided based on operator discretion. When performing prestenting balloon angioplasty before BES insertion, the smallest balloon (1.5-2.0 mm) available was used for...

Angioplasty and Stenting of Intracranial Arterial Stenosis in Perforator-Bearing Segments: A Comparison Between the Anterior and the Posterior Circulation

“…A strong point of our study was the rigorous assessment of peri-interventional clinical silent ischemic lesions on DWI MRI after PTA(S), which has only been published in two retrospective Asian case series so far ( 20 , 21 ). The observed high rate of asymptomatic DWI lesions in one third of our Caucasian patients was in line with the reported 31.7% in 123 Korean patients ( 20 ), and lower compared to 46% in 50 Chinese patients ( 21 ). Other interventional procedures such as carotid stenting and transcatheter aortic valve implantations have also found such high rates of new embolic brain DWI lesions ( 22 , 23 ).…”

Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin—Neuroimaging Perspectives

“…In preventive intervention for ICAS, the incidence of symptomatic complications was high after intracranial stenting for perforator-bearing segments or in patients with branch occlusive disease (BOD) with subcortical infarcts caused by occluding the perforator orifice (32–34). The involved segment was more diffuse and positive remodeling was less frequently observed in BOD-type ICAS than in non-BOD-type ICAS (35, 36).…”